Summary of findings 2. Taxane followed by anthracyclines compared to anthracyclines followed by taxane in adjuvant therapy for early breast cancer.
| Taxane followed by anthracyclines compared to anthracyclines followed by taxane in adjuvant therapy for early breast cancer | ||||||
| Patient or population: adjuvant therapy for early breast cancer Setting: outpatient Intervention: taxane followed by anthracyclines Comparison: anthracyclines followed by taxane | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with anthracyclines followed by taxane | Risk with taxane followed by anthracyclines | |||||
| Overall survival | — | — | — | — | — | Not reported |
| Disease‐free survival | — | — | — | — | — | Not reported |
|
Adverse events: neutropenia (grade 3/4) (follow‐up: up to 3.5 or 4.5 months) |
Study population | RR 0.62 (0.40 to 0.97) | 279 (4 RCTs, 5 treatment comparisons) | ⊕⊕⊕⊝ Higha | — | |
| 255 per 1000 | 158 per 1000 (102 to 248) | |||||
|
Adverse events: neurotoxicity (grade 3/4) (follow‐up: up to 4 or 4.5 months) |
Study population | RR 0.78 (0.25 to 2.46) | 162 (3 RCTs) | ⊕⊕⊝⊝ Lowb | — | |
| 63 per 1000 | 49 per 1000 (16 to 156) | |||||
|
Treatment adherence (defined as dose delay) (follow‐up: up to 3.5 or 4.5 months) |
Study population | RR 0.76 (0.52 to 1.12) | 238 (3 RCTs, 4 treatment comparisons) | ⊕⊕⊕⊝ Moderatec | — | |
| 333 per 1000 | 253 per 1000 (173 to 373) | |||||
|
Quality of life (follow‐up: up to 4 months) |
1 study reported quality of life data using the FACT‐B version 4 questionnaire (Puhalla 2008). Scores were similar in both groups for a subset of 20 participants who were assessed before, during and after treatment. Numerical or further details were not provided in the trial publication. | — | 20 (1 RCT) | ⊕⊕⊕⊝ Moderated | — | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
aWe did not downgrade the certainty of the evidence. A lack of blinding was judged to be unlikely to influence physician assessment of grade 3/4 neutropenia (blood tests) and there was no heterogeneity detected across studies. bThe confidence intervals were very wide and the impact of unblinding on the assessment of neurotoxicity was unclear. Therefore, we downgraded by one level for imprecision and one level for risk of bias. cThe study was open‐label with no independent assessment of this outcome. We did not think that the risk of bias was overly serious due to the design of the study where participants received both treatment drugs but in a different order. The confidence intervals were wide and the optimal information size was not meet. Therefore, we downgraded by one level for both imprecision and risk of bias. dInformation for this outcome derived from a very small sample size (from one study). Therefore, we downgraded by one level due to imprecision. We did not downgrade for risk of bias despite this being an open‐label study. This is because all participants received the same treatment though in a different order and this was unlikely to influence participant‐reported responses.